Provider Demographics
NPI:1376166637
Name:SPRINGFIELD ILLINOIS HOMECARE LLC
Entity Type:Organization
Organization Name:SPRINGFIELD ILLINOIS HOMECARE LLC
Other - Org Name:VISITING ANGELS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:217-299-2928
Mailing Address - Street 1:2731 S MACARTHUR BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-5081
Mailing Address - Country:US
Mailing Address - Phone:217-299-2928
Mailing Address - Fax:217-568-6309
Practice Address - Street 1:2731 S MACARTHUR BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-5081
Practice Address - Country:US
Practice Address - Phone:217-299-2928
Practice Address - Fax:217-568-6309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3001655OtherPRIVATE PAY ETC